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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNiIAi. FF.F. and RF.P(lRT RF.OiiFST <br />Robinson Brick Company <br />M-1984-076 <br />DDD <br />August 9, 2003 <br />RECEIVED <br />AUG 0 8 1003 <br />Birision ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Elbert <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall'submit-the annual-fee,-a report and-map showing the extent oI currant disturbances to affect3-Iand,'- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach xnnr revised written anneal re~nrt and anneal r~nrt map to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: ""~°`^ ' r'.' _:a:°` <br />Permittee Name: Robinson Brick Company <br />Address: 1845 W. Dartmouth Ave. <br /> <br />--Phone Number:- _ -(30383-304- <br />Fax Number: -F~i.$._ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Si afore of Corporate Of cer, ner, or Designee <br />~ 1.~a9 <br />Dat <br />$~ <br />MiPERMITMASTERDOCUMENTSUI-AF-OI <br />